Clinical Ophthalmology (May 2020)
Self-Retained Cryopreserved Amniotic Membrane for the Management of Corneal Ulcers
Abstract
Daniel Brocks,1 Olivia G Mead,2 Sean Tighe,3,4 Scheffer CG Tseng2 1BostonSight, Needham, MA, USA; 2Ocular Surface Center and TissueTech Inc, Miami, FL, USA; 3Department of Ophthalmology, Florida International University, Miami, FL, USA; 4Department of Biochemistry and Molecular Biology, University of Miami, Miami, FL, USACorrespondence: Daniel BrocksBostonSight, 464 Hillside Ave Suite 205, Needham, MA 02494, USATel +1 781 726 7337Email [email protected]: To evaluate the clinical outcomes of self-retained cryopreserved amniotic membrane (cAM) for the treatment of corneal ulcers.Methods: This was a single-center, retrospective review of consecutive patients with non-healing corneal ulcers that underwent treatment with self-retained cAM (PROKERA® Slim). The primary outcome measure was time to complete corneal epithelialization. Ocular discomfort, corneal staining, corneal signs, and visual acuity were assessed at 1 week, 1 month, 3 months, and 6 months. Complications, adverse events, and ulcer recurrence were also recorded.Results: A total of 13 eyes (13 patients) with recalcitrant corneal ulcers were included for analysis, 9 (69%) of which progressed from neurotrophic keratitis (NK). Prior to cAM application, patients used conventional treatments such as artificial tears (n = 11), antibiotics (n = 11), ointment (n = 11), steroids (n = 6), and antivirals (n = 3). Self-retained cAMs (n = 1.5 ± 0.8) were placed for 6.8 ± 3.4 days, during which time antibiotics were continued. Four cases (31%) were subsequently treated with bandage contact lens (n = 3) and tarsorrhaphy (n = 1). All corneal ulcers healed in a median of 14 days (range: 4– 43). This was accompanied by a significant improvement in ocular discomfort, corneal staining, and corneal signs at 1 week, 1 month, 3 months, and 6 months (P<.05). Recurrence was noted in one case. No adverse events were observed.Conclusion: Self-retained cAM may be a valuable, in-office treatment option for healing recalcitrant corneal ulcers of various etiologies, especially those with underlying NK. Further prospective, controlled studies are warranted.Keywords: amniotic membrane, corneal ulcer, neurotrophic keratitis, ocular surface disease
